Odontologia

Periodontology 2000, Vol. 8, 1995, 7-10 Primed in Denmark . All rights reserved

Copyright 0 Munksgaard 1995

PERIODONTOLOGY 2000
lSSN 0906-6713

Introduction
SEBASTIAN CIANCIO G.

Procedures for control of supragingival plaque are as old as recorded history (1, 2, 7-9). As early as 3000 B.C., gold and silver toothpicks were buried by the Sumerians with their dead. Hippocrates’ (460-377B.C.) writings include a commentary on the importance of removing deposits from tooth surfaces. The teachings of Mohammed (600-632 A.D.) stress the importance of clean teeth and their effect on health and general well-being. Following his death, an Arabic physician, Albucosis (930-1013 A.D.), wrote on this topic in more detail. The dental profession has continued this concept of tooth cleansing,changed the terminology, developed theories of motivation and invented new devices to remove dental plaque. Chemicals have been advocated for plaque reduction beginning with a clinical recommendation as early as 2700 B.C. in which it was suggested that the mouth should be rinsed with urine from a child, a recommendation also found in European writings over the years (13). Other recommendationshave included beer, wine, honey, alum, vinegar, dill, anise seed, myrrh, and pastes derived from animal parts (5). A book published in 1839 in the United States (3) states: “the enamel shall be kept free from all stains, and if it cannot be done by use of the brush alone, a dentifrice should be used three or four times a week, until the object be obtained.” The author went on to give his dentifriceformula, which consisted of equal parts of oris root, chalk and pumice stone. Today, with advanced chemical engineering a number of products are marketed for plaque reduction. Are they better than the old formulas? For some products, definitely yes but, for many products, a strong no. We now understand plaque in a broader perspective. We know that it is composed of approximately 75% bacteria and20% organic and inorganic solids; the remainder is water and a variety of cells. The

bacteria in dental plaque - although present to some extent in all healthy mouths - are responsible for tooth decay and periodontal disease. The bacterial population is in a continuous state of change and is affected by the individual’s age, oral hygiene habits (that is, the frequency and thoroughness of brushingand flossing), diet and the location of the deposits on the teeth. The amount of plaque formed is about the same in men as in women, but it has been noted that women tend to remove it better and, therefore, have less accumulated plaque on their teeth. The plaque that forms in children’s mouths is different from adult plaque in that it contains more Streptococcus mutans, which is a primary causeof caries. The type of plaque that forms in the adult mouth is usually associated more with periodontal disease than with caries. Since supragingival plaque is the first deposit to form on teeth after pellicle formation, its prevention and control are critical to the prevention of subgingiVal plaque formation. We now realize that the primary source of organisms in the subgingival flora issupragingival plaque; and the perpetuation of the subgingival flora depends on the presence of supragingival plaque. These premises are supported by reports indicating that the quantity of facultative subgingival flora is directly related to its proximity to the gingival margin (6), that subgingival plaque formation follows supragingival plaque formation (4), and that, as supragingival plaque matures,gingivitis develops. As this progression of events occurs, there is an increase in the percentage of “Bacteroides” spp., spirochetes (7, 12) and other anaerobes. In monkeys with ligature-induced periodontitis and in humans, removal of supragingival plaque has led to reduced subgingival bacterial counts (10, 11). Current research has provided knowledge not only about the bacterial composition of...